New User Confusion

[babydinosnoreless]

I have a question for all, as my confusion continues due to newness at this game.

I have just tested the ResMed AirSense 10 Auto Set for a few nights, and am currently working with the Respironics DreamStation 2 (with a data card, but no Oscar integration).

In the meantime, why am I seeing fluctuations in AHI's that range from 2.9 to 10, with average of 6.5? If the APAP's (both Philips and ResMed showed the fluctuations) are supposed to tame the apneas, why would both these machines be able to do a good job on a few nights, a poorer job on other nights, and an average job overall on most nights (resulting in an average for the month of 6.5 AHI)? Yes, I have had mask leaks over a few nights, but both machines say 100% mask fit, and for the last month, the machines are showing 28 nights with no leaks. What I don't get is why the same pressures seem to work well on certain nights and not so well on others. I have moved to side sleeping, so that I can control apnea events, and have been diligent about not being on my back where my apnea index is significantly higher (per the lab study). Sure, it's possible that I slip to my back (my preference before CPAP), but I have never awakened to find myself on my back.

I realize that this is a basic question from a novice; but my confusion continues, and any thoughts would be appreciated.

Philips Respironics DreamStation 2
Mask: ResMed AirTouch 20
Settings: Minimum 7.5/Maximum 14.5

As Pugsy mentioned it has to do with what we call swj (sleep wake junk) the machine doesn't know when we are awake and counts all events like real apneas as if they are real. Some nights we fall asleep right away and other times we lay there awake for a while. Sometimes we sleep deep and have a great night other times aches and pains wake us frequently and we twist and turn and though it may feel like we are asleep but we are more drifting in and out not really asleep. The machine doesn't know and counts all events like they are real. Most nights my AHI is under one but last two nights its been 1.5. My pain level is up from weather changing and the smoke in the air from the fires has given me a terrible headache. My real ahi is probably still under 1 but the machine is reading higher just because I'm not sleeping so great due to other factors. Once you have looked at oscar data for a while you will be able to recognize those events and just mentally toss them out of your ahi.

[Pugsy]

Watch the videos here.
While it talks mainly about CA/central apneas and arousal related flagging...what I call false positive flagging....bear in mind we can have arousal related flagging in any event category. It isn't limited to centrals.
http://freecpapadvice.com/sleepyhead-free-software
OSCAR is base on SleepyHead so all of what you see mentioning SleepyHead pertains to OSCAR as well.

And...we don't sleep the same each night. Some nights we might not sleep well at all for any number of reasons and still have a high AHI from SWJ or those arousal false positives.
A while back I woke up to an AHI of 9.4. Extremely high for me and way out of range from what I normally see.
95% was SWJ false positives.... then I remembered...horribly fragmented sleep because of pain. I had overdone it working in my garden the day before and paid for it with a bad night in terms of back pain.

If you aren't sleeping solidly for the most part and you are having much time spent with the mask and machine on there is a good chance that you are having some false positive flagging. If you aren't asleep they simply don't count...at least in terms of sleep apnea treatment evaluation.

[BSH392]

Thanks Babydinosnoreless and Pugsy,

I am starting to understand the concept. I am sure that when I have access to Oscar for DreamStation 2 (hopefully soon), this will make even more sense. Could this also be the case with what my Dream Station 2 is flagging as "Clear Airway Apneas?" Although my lab sleep study showed an equal amount of centrals, OSA's, and hypopneas, the Dream Station software generally flags 50% to 66% of my apnea events as "Clear Airway." I'm not sure how to handle pressure setting because of that. If it's "sleep junk" do I just ignore it?

I am also considering a 2nd machine to become my primary, but am delaying to see if I would be better off with a BIPAP or more likely will hold for the new ResMed 11 (which looks like a potentially nice update from the 7-year old machine ResMed AirSense10 AutoSet, albeit a workhorse machine). Any thoughts on this issue of machine choice, as well?

Thanks.

[Pugsy]

If it's "sleep junk" do I just ignore it?

Yep...awake flagged stuff doesn't count. You can't fix it with pressure tweaks...you have to fix the fragmented sleep itself causing the awake time. Easier said than done though. First have to figure out what is causing it which isn't always easy and then fixing it isn't always easy either.

You can't fix real centrals with pressure tweaks either...unless the pressure is the cause of the centrals and reducing the pressure reduces the centrals....but then that opens up the chance of not dealing with obstructives with lower pressures.

[BSH392]

I am now approaching 60 days into my APAP journey. AHI is averaging below 5, with a high percentage of Centrals-- up to 80% every night. OSA seems totally controlled.

Still trying to find the right mask. I am seeing large leaks on the Oscar charts for a new nasal mask that I am using. I am not feeling the leaks during the night, and they did not wake me. By comparison, my Oscar reports for my Full Face Mask on all previous nights show virtually no leaking. I am already using a cervical collar, and I do not choose to use a chin strap or tape. Do you suggest that I stay with a FFM, since leaking (and mouth breathing) is solved on the FFM, and the nasal is showing high leaks and probably mouth breathing (see attached).

Still fragmented sleep sessions that are strung together. Would love not to wake up 3 times per night. Overall, however, I feel that I am doing much better on APAP than prior, feeling better during the day, nocturia reductions at night, even improvement in blood pressure. I have been doing O2 Saturation monitoring with SleepU device, and that also looks very good (despite some initial concerns about desat during my sleep tests). I am waiting out the Centrals, to see if they reduce. If not, will have to see if I can live with them, or hit my doctor up for another device, though centrals are less than 5 AHI every night. Advice on mask problem and any comments overall would be welcomed. Thanks.

ResMed AirSense 10 Auto Set
Pressures 8/14
AirTouch F20 Mask (trying to use Air Touch F20
Also have DreamStation 2 as Secondary

[Pugsy]

I think a sizable chunk of your flagged centrals are arousal/awake breathing false positive flagging. They don't count and have to be mentally removed from the AHI figures.
It's normal to have an occasional central that is a real asleep central.
Quit worrying about the centrals for now...even if every single one of them was a real asleep central (which some of them aren't) you don't have enough to warrant a different machine.

Concentrate on sleep quality and whatever it is that is causing the wake ups.

Use which ever mask is the most comfort and you can sleep the best with.

[BSH392]

Good advice, Pugsy. Thanks so much.